MEDICARE: DR. KARMEL L CAROTHERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	100514	MO

General Provider Information

NPI Number	:	1427006543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARMEL L CAROTHERS M.D.

Provider Business Mailing Address
First Line	:	4721 S CLIFF AVE
Second Line	:	SUITE 200
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6969
Country	:	US
Telephone Number	:	816-503-3700
Fax Number	:	816-503-3704

Provider Business Practice Location Address
First Line	:	4721 S CLIFF AVE
Second Line	:	SUITE 200
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6969
Country	:	US
Telephone Number	:	816-503-3700
Fax Number	:	816-503-3704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/14/2014

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